It is a well-known fact that the medical sphere and ethics have always tightly intertwined. Since the times of Hippocrates, people have asked themselves about different ethical dilemmas associated with relations between the physicians and their patients. With the advancement of technology and knowledge in the modern medical practice, the old ethical issues have become enriched with modern ones. The peculiarity of the latter one has spread in terms of complexity regarding such ethical problems as the body organs transplantation and modification. Moreover, the vast majority of ethical issues in medicine have gained a global character. This fact is connected with the status of the patients and physicians in different countries due to the nation’s stage of economic and technical progress. All in all, the modern world of medical knowledge and service is imbalanced. The phenomenon occurs because of such issues as poverty and threats of the global spread of the infectious diseases, and so on. Therefore, the issues mentioned above are analyzed in the following paper with the help of the modern approaches and practices; the set of solutions for the mentioned range of ethical problems is also provided.
Disparities in Access to the Health Care and Health Status
The first issue to be considered is the inequality in terms of the benefits of medical research, access to health care, and health status. The World Health Organization addresses it in its bulletin. The essence of this question lies in the unequal allocation of material and intellectual resources both between people in one country and people from different countries. For instance, such countries as Germany, France, and the UAE have a better economic position in the world. Therefore, they have a wide range of qualified specialists in medicine that can treat various diseases effectively due to their knowledge and practical skills. In contrast, Nigeria and Bangladesh have neither a better economic condition nor qualified specialists. The reasons for the problems in the health sector may vary. For example, Bangladesh faces drastic challenges in medicine because of poverty. According to the statistics, “child and mother malnutrition rate (70%) in Bangladesh remains highest in the world, and more severe than that of the most other developing countries, including Sub-Saharan Africa”. The overall poor literacy of the population leads to the lack of knowledge about the hygiene and disease transmission factors, which aggravates the situation dramatically. At the same time, Nigeria has skillful and experienced physicians. However, they prefer working away from their country because of the decay in the national health sector. They wait for this sphere to be revamped because currently, Nigeria is reported “as one of the countries that spend the least per individual for healthcare”. The problems of this kind should be solved taking into account the major ethics concepts in medicine. Along with the theory of utilitarianism and ethical principle of beneficence, the advances of technology and knowledge should be spread among all societies equally. Therefore, the WHO and other international organizations should develop a program aimed at the cooperation with both the governments and medical organizations in countries that face the discussed challenge.
Response to the Threat of Infectious Diseases
It should be mentioned that the WHO is greatly concerned about the importance of the response to infectious diseases. In terms of ethics, its character is rather controversial. It is generally agreed that such diseases as tuberculosis or pandemic influenza require a set of procedures in order to manage their uncontrolled spread. The level of treatment of such diseases varies from one country to another. However, the basic requirements for isolation and quarantine raise questions about restricting the people’s choices and decisions. Of course, such requirements are meant to ensure the protection of the population from the infection. Nevertheless, certain steps should be made; they should aim at the development of medical treatment in terms of ensuring both protection and absence of any restrictions on the basic rights of an infected person. The following should be implied in accordance with the principle of least harm, which is applied when neither choice is beneficial. It also has to be shared with the principle of autonomy, according to which people should be allowed to decide on choices in their lives. One of the possible solutions might be the usage of the portable air filters or respirators that employ advanced technologies. However, the cases of such diseases as Ebola, when the infection is non-respiratory, require thorough research of the issue. In order to solve the problem of this kind, one can offer financial compensation for the time when a person is quarantined. This means would partially help the situation in terms of the abuse of personal rights to movement.
International Cooperation in the Health Monitoring and Surveillance
The next thing to be addressed is the problem of ethics during the process of implementation of the international medical practices dealing with monitoring and surveillance. First, some initiatives require gathering of biometrical and other private data for various analyses. Such cases violate the person’s right for the safety of his or her private data. One more concern where ethics clashes with the global medical initiatives of cooperation is the equality of the countries involved in the process. According to the International Health Regulation, “WHO shall provide appropriate guidance and assistance to other States Parties affected or threatened by the public health emergency of international concern”. However, Bhutta claims that there is a controversy facing the equality of countries sharing the initiatives. For instance, some initiatives of the community participation and informed consent tend to be shared equally between the participating countries. Nevertheless, in the developing countries, the standards of care and prior agreements are left behind. Therefore, globalization and complex international initiatives should address the questions of bioethics. According to the theory of utilitarianism, if an ethical choice is correct, it should be applied to all people for the greater good. Thus, this approach should be practiced in the global health care strategies.
Exploitation of Individuals in the Low-Income Countries
The problem of economic inequality in different countries raises a wide range of bioethical questions. Among the mentioned above issues, one can name the problem of exploitation of individuals in the developing countries. In some modern practices in medicine, individuals from the poor communities might face the risks of disproportionate allocation of possible benefits. One of the questions addressed by the WHO is the pressure of obligations enforced by the medical research sponsors on the local communities. Moreover, the WHO addresses the issue of the transplant tourism caused by the rapid development of the organ transplantation practice. The reason for this phenomenon might be the situation when individuals from the poor communities consider the possibility of selling organs in order to better their financial condition. This problem addresses serious bioethical dilemma because the socially disadvantaged people become exposed to great danger to their health and condition. One should not break the ethical principles of autonomy and justice by pushing poor people towards harmful decisions. Therefore, a global and local set of bioethical restrictions should be introduced in order to protect the rights of individuals from the developing countries. The vivid example of this can be the process of bioethics legislation in the Islamic Republic of Iran. In 2000 it has released the National Code of Ethics in Biomedical Research. It was followed by the Deceased and Brain-Dead Patients Organ Transplantation Act, Embryo Donation to Infertile Spouses Act and the Therapeutic Abortion Act.
One of the global bioethical dilemmas addressed by the WHO is the health promotion. It is claimed that while the national governments collectively respond to the global infectious diseases, there is a vast number of noncommunicable diseases to be addressed. The majority of them is the result of an unhealthy way of living. Unhealthy behaviors such as smoking, poor diet, and lack of exercise raise the question of the extent, to which the public health authorities should interfere with the personal choices of health. For instance, the recent studies in the UAE have shown that “thirty per cent of six to 18-year-olds are either obese or overweight … nearly 10 per cent of children under the age of five in the emirate are anaemic, according to a 2010 study. UAE schoolchildren are 1.8 times more obese than US children”. In the light of the absence of local and global strategies of raising social awareness about unhealthy behavior, the freedom of choice is the question of national importance. With obesity, smoking, and poor diet taking high rates, any nation faces a danger of numerous diseases and poor quality of life. Therefore, the governments should address the issue of implementing the social health and awareness initiatives balancing between the principles of least harm and respect for autonomy. Such initiatives should address the population explaining the threats caused by the unhealthy lifestyle. Health promotion should be one of the primary concerns in any country.
Participation, Transparency, and Accountability
One more aspect addressed by the WHO is the importance of participation, transparency, and accountability in medicine. It highlights the need for both the process of making a medical decision and the outcomes of this decision to be controlled and analyzed. Therefore, the questions of the informed consent and community oversight deserve special attention. The importance of the analysis of the medical theories and practice together with a comprehensive system of regulations in the public health can be witnessed on the example of the UAE. It is claimed that the sphere of public health in the UAE “has displayed extraordinary growth and significant progress in the past few years”(White Paper). The reason for this achievement is the creation of a developed medical infrastructure that is shared under the regulation of the Ministry of Health, the Dubai Health Authority, and the Emirates Health Authority. Regulations in the healthcare planning, pharmacy, medical devices, and biotechnologies allow boosting the development of public medicine in the UAE. Moreover, the existence of Patient and Family Bill of Rights and Responsibilities makes such issues as the informed consent obligatory. The latter raises the quality of treatment and lowers the range of bioethical dilemmas by supporting the theory of utilitarianism and following the principle of respect of autonomy. Therefore, in order to improve the quality of medical treatment, an example of the UAE should be followed by all countries worldwide.
Summing up the presented information, one should admit that the WHO raises a set of important bioethical issues that influence the contemporary world. These issues are to be addressed by all the countries in order to balance the desire to cure people and maintain their rights and freedoms. There are some cases where certain countries require a help of the world community. Moreover, there are cases when the global community can adopt an example of a country that has successfully streamlined its public health care. The global bioethical issues require global solutions. That is why, the national governments and businesses have to cooperate and act together by sharing the democratic principles of regulation.